New York State Agency Department
330 Old Country Road, Third Floor
Mineola, New York 11501
Mineola Office (516) 296-4600 or (516) 741-4104
Buffalo Office (716) 362-0630
Westbury Office (516) 334-6727
White Plains Office (914) 682-3900
REQUEST FOR TITLE PLANT MATERIALS
Please deliver this form to:
Wayne Nathan/Nancy Prokop
FIDELITY/ CHICAGO/TICOR/COMMONWEALTH/LAWYERS
ALL Counties
Agency Department
Fax: 516-334-9640
[email protected]
BRAND X ________
(REQUIRED* - Check the underwriter that will insure new title) Chicago ______ Fidelity ______ Commonwealth _______
(REQUIRED* – Agent file/title number: _________________________ Estimated closing date: _______________________
(REQUIRED* – Agent certifies they are writing the new title policy associated with this request through one of the abovementioned brands: _______________________________________________________(signature required)
* request will not processed without this information
Agency Name: _______________________________________________________
Requested by: _______________________________________
Date of Request: __________________________________
Agency Fax No.: _____________________________________
Agency Telephone No.: _____________________________
Agency email: _______________________________________
Premises:
County
Town
Village
District/Section
Back file #:
Please provide us with a copy of the following material from your plant:
[ ] Survey
[ ] Marked-up title report
[ ] Policy
RESPONSE FROM FIDELITY NATIONAL TITLE GROUP
Number of pages in this fax ___________________
[ ] Survey is attached
[ ] Survey cannot be located
[ ] Report/Policy is attached
[ ] Report/Policy cannot be located
[ ] Not a Back File number we would have stored in our plant
[ ] Please contact _______________________________ for their back title material.
Block/Lot